不同一线化疗方案治疗晚期卵巢癌的毒性：一项网状Meta分析。

Toxicities of different first-line chemotherapy regimens in the treatment of advanced ovarian cancer: A network meta-analysis.

作者信息

Qu Chang-Ping, Sun Gui-Xia, Yang Shao-Qin, Tian Jun, Si Jin-Ge, Wang Yi-Feng

机构信息

Department of Gynecology & Obstetrics, Huaihe Hospital of Henan University, Kaifeng

Department of Gynecology and Obstetrics, Southern Medical University, Guangzhou, P.R. China.

出版信息

Medicine (Baltimore). 2017 Jan;96(2):e5797. doi: 10.1097/MD.0000000000005797.

DOI:10.1097/MD.0000000000005797

PMID:28079805

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5266167/

Abstract

BACKGROUND

Ovarian cancer (OC) is the 5th leading cause of cancer-related deaths around the world, and several chemotherapy regimens have been applied in the treatment of OC. We aim to compare toxicities of different chemotherapy regimens in the treatment of advanced ovarian cancer (AOC) using network meta-analysis.

METHODS

Literature research in Cochrane Library, PubMed, and EMBASE was performed up to November 2015. Eligible randomized controlled trials (RCTs) of different chemotherapy regimens were included. Network meta-analysis combined direct and indirect evidence to assess pooled odds ratios (ORs) and draw the surface under the cumulative ranking (SUCRA) curves.

RESULTS

Thirteen eligible RCTs were included in this network meta-analysis, including 8 chemotherapy regimens (paclitaxel + carboplatin [PC], pegylated liposomal doxorubicin [PLD] + carboplatin, carboplatin, gemcitabine + carboplatin, paclitaxel, PC + epirubicin, PC + topotecan, docetaxel + carboplatin). Gemcitabine + carboplatin regimen exerted higher incidence of anemia when compared with carboplatin and paclitaxel regimens. The incidence of febrile neutropenia of gemcitabine + carboplatin regimen was higher than that of PC, PLD + carboplatin, carboplatin, and PC + topotecan regimens. Topotecan PC + epirubicin regimen had a higher toxicity, comparing with PC, PLD + carboplatin, and PC + topotecan regimens. As for thrombocytopenia, gemcitabine + carboplatin chemotherapy regimen produced an obviously higher toxicity than PC and carboplatin. As for nausea, PLD + carboplatin chemotherapy regimen had a significantly higher toxicity than that of carboplatin chemotherapy regimen. Moreover, when compared with PC and carboplatin chemotherapy regimens, the toxicity of PC + epirubicin was greatly higher to patients with AOC.

CONCLUSION

The nonhematologic toxicity of PLD + carboplatin regimen was higher than other regimens, which was clinically significant for the treatment of AOC.

摘要

背景

卵巢癌（OC）是全球癌症相关死亡的第五大主要原因，几种化疗方案已应用于OC的治疗。我们旨在使用网络荟萃分析比较不同化疗方案治疗晚期卵巢癌（AOC）的毒性。

方法

截至2015年11月，在Cochrane图书馆、PubMed和EMBASE进行文献研究。纳入不同化疗方案的合格随机对照试验（RCT）。网络荟萃分析结合直接和间接证据来评估合并比值比（OR）并绘制累积排名曲线下的面积（SUCRA）曲线。

结果

该网络荟萃分析纳入了13项合格的RCT，包括8种化疗方案（紫杉醇+卡铂[PC]、聚乙二醇化脂质体阿霉素[PLD]+卡铂、卡铂、吉西他滨+卡铂、紫杉醇、PC+表柔比星、PC+拓扑替康、多西他赛+卡铂）。与卡铂和紫杉醇方案相比，吉西他滨+卡铂方案的贫血发生率更高。吉西他滨+卡铂方案的发热性中性粒细胞减少发生率高于PC、PLD+卡铂、卡铂和PC+拓扑替康方案。与PC、PLD+卡铂和PC+拓扑替康方案相比，拓扑替康PC+表柔比星方案的毒性更高。至于血小板减少，吉西他滨+卡铂化疗方案的毒性明显高于PC和卡铂。至于恶心，PLD+卡铂化疗方案的毒性明显高于卡铂化疗方案。此外，与PC和卡铂化疗方案相比，PC+表柔比星对AOC患者的毒性要高得多。